Intimate partner violence (IPV) is a national problem that knows no ethnic, social, age, or gender boundaries. The emergency department is often a place that IPV victims turn to for help. Whether they seek help for injuries related to violent episodes or for proxy care for other complaints, the emergency department (ED) may be an entry point for victims to receive the assistance they need to remove themselves from a potentially deadly situation.
The statistics are staggering:
- Nationally, each year more than one million women seek medical assistance for injuries resulting from battering and domestic violence.
- 37% of women seeking injury related ED treatments are there because of injuries inflicted by a current or former intimate partner.
- As many as 1/4 to 2/3 of battered women report abuse during pregnancy.
- Over 70% of IPV survivors report that they would have liked their healthcare providers to ask them privately about intimate partner violence.
- Domestic violence hotlines answer on average 10 calls every hour.
Hear no evil:
Most health care professionals lack the education needed to screen and identify IPV. Many victims do not come forth with an accurate story for their ED visit. They often are fearful. Fear of being injured or killed keeps many women in abusive relationships and from reaching out for help. Other reasons victims stay in abusive relationships are related to economic dependence, children, isolation, shame, past failures of the system to respond, and religious and/or societal pressures. Batterers work hard to ensure that their victims stay. Victims therefore will say their injuries are accidental. If the healthcare professional is not listening for the “real story” or reading between the lines, IPV may go unrecognized.
See no evil:
While some IPV leave no visible marks, injuries may be the clue to detecting IPV. Pattern injuries (like those seen when hit with an object or an open hand) and a strangulation assessment may tip a healthcare provider to IPV. Strangulation is a common form of IPV. Nearly 4 in 5 victims of strangulation are strangled using just hands. Recognizable symptoms of strangulation can include voice changes, neck pain, difficulty swallowing or breathing, ear pain, vomiting blood, vision change, tongue swelling, bloodshot eyes, and lightheadedness. While there may be no signs of strangulation, healthcare providers will look closely at the neck for marks but also examine the eyes, ears, and mouth for other subtle marks. We know that women who survive strangulation by their partner are seven times more likely to be the victim of an attempted homicide, and eight times more likely to be a victim of homicide. Strangulation is ominous in IPV.
Speak no evil:
At the University of Louisville Department of Emergency Medicine, it starts at the front door. When a patient regardless of age, gender, or ethnicity is triaged, they are asked a series of screening questions. Knowing that the presenting complaint may be a proxy for the deeper underlying issue all patients are assessed for domestic violence. Domestic violence knows no boundaries; screen everyone. Healthcare workers should also probe deeper if the story doesn’t match the presentation. Some IPV victims will not volunteer information upfront, they need the healthcare professional to ask the pointed questions that they are afraid to volunteer upfront.
- Have you been hit, kicked, punched, strangled, or otherwise hurt by someone in the past year? If so, by whom?
- Do you feel unsafe in your current relationship?
- Is there a partner from a previous relationship who is making you feel unsafe now?
- Are you here today for injuries related to intimate partner violence?
Together we can make a difference. The University of Louisville Hospital and its partnership with Center for Women and Families are on the forefront of IPV identification, treatment, and survival. Patients can finally receive the help they need to literally safe their lives.
Written by: Dr. Melissa Platt, MD
Medical Advisor, Sexual Assault Forensic Examiner (SAFE) Service, University of Louisville Hospital
References
Beynon CE, Gutmanis IA, Tutty LM, Wathen CN, MacMillan HL. Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis. BMC Public Health. 2012;12:473.
Gutmanis I, Beynon C, Tutty L, Wathen CN, MacMillan HL. Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC Public Health. 2007;7:12.
Centers for Disease Control and Prevention. Intimate partner violence: definitions. Available at http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/definitions.html. August 2013.
Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate Partner Violence Surveillance: Uniform Definitions and Recommended Data Elements. Version 1. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2002.
Domestic Violence Intervention Project. The Power and Control Wheel. Available at http://www.theduluthmodel.org/training/wheels.html. August 2013.
Koop CE, Lundberg GD. Violence in America: a public health emergency: time to bite the bullet back. JAMA. 1992;267(22):3075-3076.
McAfee RE. Physicians and domestic violence. Can we make a difference? JAMA. 1995;273(22):1790-1792.
